Tag Archives: Bone Grafting

Dental Implants

Dental Implant Incompetence

Can you help me? I had two dental implants placed. One of them felt loose to me. I went back to the dentist and he did an x-ray and said that the implant itself was fine. He felt it was just a matter of the dental crown being loose. He said that was easy to take off and cement back on. He started to work on it but it felt stuck, so he got some special tool. He was yanking hard. But, when the crown came off, the dental implant came with it! Do implants usually do that with tough crowns?

Jeremiah

Dear Jeremiah,

illustration of a dental implant

I actually had to take a step back and walk away for a moment after reading your experience. The level of incompetence that it would take for your dentist to do this is almost unbelievable. Obviously, it was not the crown that was loose. If a crown is actually loose, then it will usually fall out without any assistance at all from the dentist. I’m not sure how in the world it did not occur to him that the problem was the dental implant itself once the crown didn’t easily slide off. It’s almost unfathomable to me.

While I am only guessing here, the amount of incompetence necessary to do this makes me wonder if he realized what the problem was and was trying to cover it up. To fix a loose crown is easy. To fix a loose implant is a big deal.

You didn’t say when this crown was placed in relation to the implant placement. It’s possible that your dentist didn’t give enough time for the bone to integrate with the implant. This is known as premature loading and can lead to the implant coming loose. Another common problem is an infection, but that is usually accompanied by pain and fever, neither of which you mentioned. There are others as well.

I’m going to recommend that you have both of these sites looked at— the one with the lost implant as well as the implant that is still there to see if an expert implant dentist can figure out what went wrong here and if your second implant is safe. Look for someone with post-doctoral training in implants as well as a high success rate (no less than 97%). When you go, don’t tell them who the dentist is that did the work. They may know one another, which can lead to a friendship conundrum for the dentist.

Replacing the failed implant will require some additional work, such as bone grafting to fill in the lost bone, but it can be done. I also think you can get a refund on the failed implant.

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Dental Implants

Deformed and Missing Teeth

I have a problem with both of my lateral incisors on my upper teeth. One of them is completely missing and never came in. The other is smaller than it should be. I want to fix this before I go to college. I have a dental flipper for the missing tooth area currently, but my parents were told that the flipper should be temporary. They both passed my senior year of high school. I stayed with some friends until graduation. I was going to use their life insurance for college, but I received a great scholarship so now I am free to use the money to fix my teeth. Do you have any suggestions?

Caroline

Dear Caroline,

illustration of a dental implant

I had so many emotions reading through your question. First, I want to express my condolences at the loss of your parents while you are yet so young. Next, I want to say congratulations on your scholarship. That is absolutely fantastic, especially given all the difficulties which you experienced during your senior year. That says a lot about your perseverance.

As to your tooth, I am going to suggest that you replace the congenitally missing tooth with a dental implant. This is the most secure tooth replacement we have. It is expensive and does require surgery, but as young as you are, it will be important in order to preserve the bone structure. You may even need some bone grafting done before the implant is placed. There are other options, such as a dental bridge, but the implant is the best option.

As for the other tooth, I am going on the assumption that it is a deformed tooth and not a baby tooth still left in place. On that assumption, you will want to use either a porcelain veneer or a porcelain crown depending on how small the incisor is.

The trick with both of these procedure will be matching the color of the implant and other restoration to the natural teeth that are adjacent to them. These are very visible teeth, which means light hits them exposing all their variations.

You will need an expert cosmetic dentist to get this done right.

Best of luck to you at university. I have a feeling you are going to accomplish great things. This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

Dental Implants

Did My Dentist Handle My Sinus Perforation Correctly?

I had a dental implant placed. During the procedure, the dentist perforated the sinus cavity by a few millimeters, which he explained is quite common. The bone never quite filled in so he eventually ended up removing the implant. I was sedated during the procedure and no antibiotics were administered. A few days later I started having congestion in the nose and a crackling sound. I wasn’t feeling well and thought I might be getting an infection. When I went in for my follow up, he told me everything looked fine. He also said that there was no need to repair the perforation and that it would heal on its own. I told him I thought I was getting an infection and insisted he prescribe me an antibiotic, to which he reluctantly agreed. Since then, I have not had any problem with the congestion. Now I am wondering if I should have had antibiotics to begin with. He said we can try again after everything is healed up. Do you know what the time period for that typically is?

Kathey

Dear Kathey,

illustration of a dental implant

Not providing you antibiotics at the beginning, when there was no sign of infection, is not a problem. However, there are a couple of other issues here that I am concerned about.

First, the sinus perforation. While they do sometimes happen, I would not exactly call it common. Even more disturbing was the amount of the perforation. In dental terms, a few millimeters is HUGE. How did this happen? Did he do the appropriate diagnostics, which would include a CT scan? This is important because dental implants are a 3 dimensional procedure, so you need 3 dimensional images. Without that, you not only risk a sinus perforation, but damaging nearby nerves.

A second thing that concerns me is that the bone never integrated with the dental implant. Did he tell you why? Was there even enough bone there to begin with? Again, I’m curious about the diagnostics which would have given an idea about the bone support.

A Second Dental Implant Procedure

Getting your implant redone is not as simple as just waiting for things to heal. Even if you had enough bone to begin with, when the implant was removed, it would have taken some bone with it.

That bone will have to be replaced in order to even attempt a second procedure. You will need to have some bone grafting done. Then, after that has had time to heal you can get the implant done.

He also needs to answer why the implant failed. If he doesn’t know, how can he assure you it won’t happen the second time. In your place, I’d ask for a copy of the original diagnostics and then take them to another dentist for a second opinion on the reason for dental implant failure.

This blog is brought to you by Lafayette, LA Dentist Drs. Foreman and Thimmesch.

Dental Implants

Dental Implant Failure…again

I went to my dentist for dental implants. He’s done quite a bit of them for other people so I felt fairly confident. When he went in for the first surgery, he ended up not giving me the dental implant because he said there was not enough bone structure to retain it. He suggested we do bone grafting. I agreed to that and had that procedure done. Two surgeries down. No implant. After had time to heal, we went in for the dental implant surgery again. Yet again, he said there is still not enough bone and he suggests now that I just get a dental bridge. Here’s what I want to know, is it still possible for me to get a dental implant? Did he do anything wrong?

Kevin

Dear Kevin,

diagram of a dental implant next to a natural tooth

I am sorry you’ve had this experience. You must be very frustrated. I have some good news for you. It is very likely you can still get the dental implant. You will just have to do it with a different dentist. You asked me if your dentist did anything wrong. That’s hard to say. I am curious what type of diagnostics he did ahead of time to determine if there was enough bone structure, but other than that, it seems like he was genuinely trying his best to give you a good outcome.

Truthfully, one thing to be grateful for about your dentist is his integrity and desire to add to his skill set. Not all dentists are even interested in learning about bone grafting let alone try and do it. Plus, when he attempted to give you a dental implant the second time, after you did the procedure he suggested, and there was still not enough bone, he was probably horribly embarrassed.

Some dentists, with less integrity, would have just placed the dental implant knowing it would fail in a few years. Instead of trying to make himself not look bad, he told you the truth, looking out for your best interest rather than his. To me, that says this dentist is a keeper. So, even after you go somewhere else to get your dental implant, I would still use this dentist for all of your other care.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

Dental Implants

Should My Husband Get All-On-Four Dental Implants?

My husband needs to replace his bottom teeth. His upper teeth have been gone for a while and he has dentures there. We were told that you shouldn’t do dentures on bottom teeth because they won’t stay in the way the top ones do. Our dentist said he needs to get all-on-4 dental implants. I just want to explore if there are other options before we make a decision?

Pricilla

Dear Pricilla,

All-on-4 Dental Implants

I am curious why that is the only option he gave your husband. A dentist is ethically obligated to give his or her patients all of their options. He is correct that dentures are a bad idea on bottom teeth. While it is true that dentures will struggle to stay in on the lower arch, that does not happen right away. This is an issue because of bone resorption.

When his teeth are removed, his body recognizes that and begins to resorb the minerals in his jawbone in an effort to be as efficient as possible with his body’s resources. The big problem with that is after ten or so years, he will no longer have enough jawbone left to retain his dentures. This is known as facial collapse.

This bone structure is important no matter what tooth replacement option he chooses.

All-on-4 Dental implants (pictured above) are what dentists will sometimes offer to patients who have lost some jawbone structure but still want dental implants. However, there are other options.

Implant-supported denture

The first thing to find out is whether or not he has lost bone structure. If he hasn’t, then his best option is to get an implant overdenture. This uses between for and six dental implants and then anchors a denture to them.

If he is missing bone, depending on the amount, he has two choices. First, he can have the all-on-4 procedure his dentist suggested, as long as he hasn’t lost too much bone. The one downside to this procedure, however, is that if one implant fails, the entire unit has to be redone. A second option, no matter how much bone he’s lost, is to have a bone grafting procedure done to build it back up. Then, he can do implant overdentures if he wants. He could get a denture too, but bear in mind he will end up with facial collapse. Having dental implants in the jaw bone, prevents that from happening.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

Dental Implants

Dental Implants Keep Falling Out

I have dentures and have for the last year. I thought I would adapt to them but really hated them. I finally decided nothing was going to change so I opted to get implant-supported dentures. I had six implants placed. In less than a week two of them have fallen out and I can tell a third one is loose. Here are my questions. Should I have to pay for the ones that came out? Do you think more of them will come out? Is there any way this can be fixed?

Clarence

Dear Clarence,

Implant Overdentures
Implant Overdentures

I will say right off the bat that you made a good choice in what procedure you chose to replace your removable dentures. Dental implants are the closest thing to having healthy, natural teeth in your mouth again.

Your big problem here is your dentist. He doesn’t seem to have any idea what he is doing. With dentists who know what they are doing, there is a 95% success rate. Your dentist has about a 50% success rate and that is just in the first week. Plus, I do not have high hopes for the remainder of your implants. I would not expect them to last.

To answer your questions, no, you should not have to pay for the dental implants that fell out. As I mentioned earlier, I don’t think you should hold out much hope on the others. What I would like you to do is see a dentist with more expertise. I’d like him or her to examine your dental implants and tell you the cause of the dental implant failure.

Reasons for Dental Implant Failure

There are quite a few reasons why dental implants can fail. Here are just a few:

  • One of the major causes of dental implant failure is infection. Often this is the result of poorly fitting dentures.
  • Some dentists try to increase their profits by purchasing sub standard implants from overseas.
  • Inadequate bone support. This is completely preventable if your dentist does the correct diagnostic procedures. If you know ahead of time (as you should from the diagnostics) that you do not have enough bone support, there is a simple solution of having a bone grafting procedure done.
  • Incorrect placement of the implant. It is important that your dentist does 3-dimensional diagnostics, such as a CT scan so that the dental implant is placed correctly. Without that, there can be poor placement that results in serious damage such as damaging a nerve or perforating your sinus cavity.
  • Premature loading—It is important that you wait for your implants to integrate wtih your jawbone. If you don’t and put weight on it with the dental crown before integration, it will cause your implants to fail.

Once you know the cause of the dental implant failure, then you can formulate a plan to get the implants you need for your implant overdentures. I think you will be better off getting a full refund from your dentist and then following the treatment plan of a dentist with a lot more experience who can do this properly.

Then, you will have a stable smile that you will be proud to share.

This blog is brought to you by Lafayette, LA Dentist Drs. Foreman and Thimmesch.

Dental Implants

Implant Placed With Poor bone Density

I need some advice about how to proceed. I went to a dentist about getting a dental implant. My dentist does not do them, so I looked for someone who advertised. We did a consultation, he took some x-rays, and said everything was fine. The day of the surgery, though, he told me when he went in he realized there wasn’t enough bone support. He put the implant in anyway. Now he wants to remove it and place a dental bridge. This cost me $3K. Should I be entitled to a refund? Am I stuck getting a dental bridge? I sort of had my heart set on an implant.

Ginny

Dear Ginny,

Dental implant diagram

I’m not sure how your dentist thinks he can get away with this. Of course you are entitled to a refund. When a dentist tells you he is providing you with a dental implant, there is a reasonable expectation that the implant will actually be able to support the implant crown. Yours will not, therefore as an implant it is absolutely useless. Your dentist should refund your money in full.

There is a bigger issue here too– Your dentist’s competency and integrity. First, if he had done adequate diagnostics, he would have known there was not enough bone support. This means he either was incompetent in reading the x-rays or he didn’t do the correct ones. Both of these mean he’s incompetent.

The other issue here is the fact that he placed the implants knowing there was not enough bone support. That is malpractice. If you decided to be nasty about it, you can get additional money. At a minimum, I think you should tell him that you want him to pay to get this done correctly. Don’t just let him give you a refund. While you can still get a dental implant and should not be relegated to a dental bridge, you will need an additional procedure.

Without the correct bone support, your implants will fail. There is a bone grafting procedure which can be done to build that back up. Once that is complete, you will be good to go for implants.

Best of luck!

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

Dental Implants

Is it Possible to Get Dental Implants after 30 Years?

I’ve had dentures for around 30 years. I’ve never been crazy about them and always wanted to switch to dental implants. Now, I’m having trouble even keeping them in. I think this may be a perfect time to switch, but I don’t know if I waited too long. Is it still possible? If not, how do I get my dentures to stay in? Not even those nasty adhesives are working.

Marilyn

Dear Marilyn,

dental implant diagram

Technically, as long as you are in reasonably good health, you can get dental implants. Though, in cases like yours, an extra step will be needed. As you can see from the image above, your dental implant will need to be surrounded by bone in order to stay in place. This bone is also what holds your teeth in place as well, along with some ligaments. After this length of time with dentures, you are missing that bone.

You’re Dealing with Facial Collapse

When your teeth were removed 30 something years ago, your body immediately began resorbing the minerals in your jawbone to use elsewhere. It does this in an effort to be efficient with your body’s resources. It knows you don’t have teeth anymore and assumes that you won’t need the bones in your jawbone to hold them. True. However, your dentures rest on the ridgeline of your jawbone. As that shrinks, there is less and less of a ridge to hold your dentures in place.

After ten years, you likely noticed them starting to slip. By thirty years, it is almost impossible to keep them in. This is known as facial collapse. You’ve probably also noticed your jawline shrinking,, which makes you look much older than you really are.

There is a procedure to help with this– Bone grafting. You can have either natural or synthetic bone built back up in the area so that you’ll have enough bone there to integrate with your dental implants and keep them in place.

Implant Overdentures

implant-overdentures
Implant Supported Dentures

Once the bone grafting is complete, then you will be able to get the dental implants you hope for. You won’t want to do a one-to-one replacement for your teeth. That is way too expensive. Instead, you’ll get implant overdentures. With these, you’ll have four to six dental implants placed in each arch and then have a new set of dentures anchored to them.

Your dentures will be completely secure and will protect you from facial collapse in the future.

This blog is brought to you by Lafayette, LA Dentists Drs. Forman and Thimmesch.

Dental Implants

Zirconia or Titanium Implants

I have three titanium dental implants and recently read that the titanium can cause neurological ill effects. I am now in need of another dental implant. Should I get the zirconia kind this time? Are they better? Should I switch out the titanium ones as well?

Carolyn

Dear Carolyn,

zirconia dental implants

I’m not sure where you read that titanium causes neurological effects. As far as I know, there are no studies with data that supports that. On the contrary, there are decades of data that show titanium to be highly biocompatible in dental implants as well as a large number of other titanium prosthetics, such as knee and hip replacements.

If you want to get a zirconia dental implant, for your new tooth replacement that is fine. You may need to do a bit of internet searching and phone calls to find a dentist who does them. Because they’re considered new, not all dentists are using them yet. You will be able to find someone though. Zirconia is definitely strong enough to work and more dentists are starting to use them. The only concern you may run up against is we don’t have the same data on their longevity the way we do their titanium counterparts. That doesn’t mean they won’t last as long, just that we don’t have the data.

As to whether or not you should switch out your current implants, I wouldn’t recommend it without a good reason to remove them. It is not simply a matter of taking out the old implants and then putting in new ones. When you remove the implants, bone will come with it. In order to place the new dental implants, you will need to have an additional procedure known as bone grafting done. Then, once that has had time to heal, you can then have the new implant placement surgery.

It’s a lot to go through and a huge expense when your dental implants are probably just fine. Plus, there is always a risk the new implants will fail. I’m sure you will find a dentist willing to do the procedure. I just want to make sure you understand what you’re getting into before moving forward.

This blog is brought to you by Lafayette, LA Dentists Drs. Thimmesch and Foreman.

Uncategorized

Can I get bone grafting done?

My general dentist has told me that I should consider getting some dental implants. I lost three teeth in a boating accident when I was a teenager. I am 40 now, and have had a dental bridge for all these years. The x-rays that my dentist takes show that there is a lot of bone loss where the teeth were, and my dentist does not want to let that situation continue.

He wants to do dental implants, and says he could do the work unless it requires bone grafting, in which case he would refer me to an oral surgeon for that. I think I would rather just go to a specialist for the whole procedure. How can you tell if you need bone grafting? My dentist did not say. Seems like you would be able to tell from the x-rays, but maybe there is more to it?

Also, how do I know if I even CAN get bone grafting done? I am not in good health. My regular doctor does not sound very excited about me undergoing surgery, though he did not say “don’t do it”. I guess all of this uncertainty is making me very nervous, and wondering if the procedure is worth the risk.

Thanks for any information you can give me,

Shelia in New Orleans, LA

Dear Shelia,

We would suggest a consultation with your dentist, the specialist you and your dentist choose to do the procedure, and your regular physician. You should be in good general health for the best chances of a successful bone grafting procedure, and you say that your health is not good. Is your general dentist fully aware of your health problems? He may change his recommendation if he has the full picture of your overall health.

The dentist who does the implants will consider your x-rays and CT scans, and then consider your case in light of all other health information. Like the field of cosmetic dentistry, dental implant dentistry is not recognized as an official speciality are by the American Dental Association, so you’ll have to be cautious about choosing the specialist. You’ll want someone who has demonstrated success with dental implants, and who has extensive training beyond dental school.

There is no one way to determine who is the best dental implant dentist in your area, but some techniques are to consult the websites of dentists in your area, and find one that advertises that he or she does dental implants. If they have pursued the extra training, chances are very good that they will mention this either on their home page or on the “About the Dentist” page. Look for training at facilities such as the International Congress of Oral Implantology, the Academy of Osseointegration, or the American Academy of Implant Dentistry.

This blog post is supported by the dental office of Lafayette Louisiana cosmetic dentist Dr. Malone.